102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
SB2972

 

Introduced 12/15/2021, by Sen. Ann Gillespie

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5A-2  from Ch. 23, par. 5A-2

    Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning assessments.


LRB102 22231 KTG 31361 b

 

 

A BILL FOR

 

SB2972LRB102 22231 KTG 31361 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Section 5A-2 as follows:
 
6    (305 ILCS 5/5A-2)  (from Ch. 23, par. 5A-2)
7    (Section scheduled to be repealed on December 31, 2022)
8    Sec. 5A-2. Assessment.
9    (a)(1) Subject to Sections 5A-3 and 5A-10, for State
10fiscal years 2009 through 2018, or as long as continued under
11Section 5A-16, an annual assessment on inpatient services is
12imposed on each hospital provider in an amount equal to
13$218.38 multiplied by the the difference of the hospital's
14occupied bed days less the hospital's Medicare bed days,
15provided, however, that the amount of $218.38 shall be
16increased by a uniform percentage to generate an amount equal
17to 75% of the State share of the payments authorized under
18Section 5A-12.5, with such increase only taking effect upon
19the date that a State share for such payments is required under
20federal law. For the period of April through June 2015, the
21amount of $218.38 used to calculate the assessment under this
22paragraph shall, by emergency rule under subsection (s) of
23Section 5-45 of the Illinois Administrative Procedure Act, be

 

 

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1increased by a uniform percentage to generate $20,250,000 in
2the aggregate for that period from all hospitals subject to
3the annual assessment under this paragraph.
4    (2) In addition to any other assessments imposed under
5this Article, effective July 1, 2016 and semi-annually
6thereafter through June 2018, or as provided in Section 5A-16,
7in addition to any federally required State share as
8authorized under paragraph (1), the amount of $218.38 shall be
9increased by a uniform percentage to generate an amount equal
10to 75% of the ACA Assessment Adjustment, as defined in
11subsection (b-6) of this Section.
12    For State fiscal years 2009 through 2018, or as provided
13in Section 5A-16, a hospital's occupied bed days and Medicare
14bed days shall be determined using the most recent data
15available from each hospital's 2005 Medicare cost report as
16contained in the Healthcare Cost Report Information System
17file, for the quarter ending on December 31, 2006, without
18regard to any subsequent adjustments or changes to such data.
19If a hospital's 2005 Medicare cost report is not contained in
20the Healthcare Cost Report Information System, then the
21Illinois Department may obtain the hospital provider's
22occupied bed days and Medicare bed days from any source
23available, including, but not limited to, records maintained
24by the hospital provider, which may be inspected at all times
25during business hours of the day by the Illinois Department or
26its duly authorized agents and employees.

 

 

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1    (3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State
2fiscal years 2019 and 2020, an annual assessment on inpatient
3services is imposed on each hospital provider in an amount
4equal to $197.19 multiplied by the difference of the
5hospital's occupied bed days less the hospital's Medicare bed
6days. For State fiscal years 2019 and 2020, a hospital's
7occupied bed days and Medicare bed days shall be determined
8using the most recent data available from each hospital's 2015
9Medicare cost report as contained in the Healthcare Cost
10Report Information System file, for the quarter ending on
11March 31, 2017, without regard to any subsequent adjustments
12or changes to such data. If a hospital's 2015 Medicare cost
13report is not contained in the Healthcare Cost Report
14Information System, then the Illinois Department may obtain
15the hospital provider's occupied bed days and Medicare bed
16days from any source available, including, but not limited to,
17records maintained by the hospital provider, which may be
18inspected at all times during business hours of the day by the
19Illinois Department or its duly authorized agents and
20employees. Notwithstanding any other provision in this
21Article, for a hospital provider that did not have a 2015
22Medicare cost report, but paid an assessment in State fiscal
23year 2018 on the basis of hypothetical data, that assessment
24amount shall be used for State fiscal years 2019 and 2020.
25    (4) Subject to Sections 5A-3 and 5A-10, for the period of
26July 1, 2020 through December 31, 2020 and calendar years 2021

 

 

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1and 2022, an annual assessment on inpatient services is
2imposed on each hospital provider in an amount equal to
3$221.50 multiplied by the difference of the hospital's
4occupied bed days less the hospital's Medicare bed days,
5provided however: for the period of July 1, 2020 through
6December 31, 2020, (i) the assessment shall be equal to 50% of
7the annual amount; and (ii) the amount of $221.50 shall be
8retroactively adjusted by a uniform percentage to generate an
9amount equal to 50% of the Assessment Adjustment, as defined
10in subsection (b-7). For the period of July 1, 2020 through
11December 31, 2020 and calendar years 2021 and 2022, a
12hospital's occupied bed days and Medicare bed days shall be
13determined using the most recent data available from each
14hospital's 2015 Medicare cost report as contained in the
15Healthcare Cost Report Information System file, for the
16quarter ending on March 31, 2017, without regard to any
17subsequent adjustments or changes to such data. If a
18hospital's 2015 Medicare cost report is not contained in the
19Healthcare Cost Report Information System, then the Illinois
20Department may obtain the hospital provider's occupied bed
21days and Medicare bed days from any source available,
22including, but not limited to, records maintained by the
23hospital provider, which may be inspected at all times during
24business hours of the day by the Illinois Department or its
25duly authorized agents and employees. Should the change in the
26assessment methodology for fiscal years 2021 through December

 

 

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131, 2022 not be approved on or before June 30, 2020, the
2assessment and payments under this Article in effect for
3fiscal year 2020 shall remain in place until the new
4assessment is approved. If the assessment methodology for July
51, 2020 through December 31, 2022, is approved on or after July
61, 2020, it shall be retroactive to July 1, 2020, subject to
7federal approval and provided that the payments authorized
8under Section 5A-12.7 have the same effective date as the new
9assessment methodology. In giving retroactive effect to the
10assessment approved after June 30, 2020, credit toward the new
11assessment shall be given for any payments of the previous
12assessment for periods after June 30, 2020. Notwithstanding
13any other provision of this Article, for a hospital provider
14that did not have a 2015 Medicare cost report, but paid an
15assessment in State Fiscal Year 2020 on the basis of
16hypothetical data, the data that was the basis for the 2020
17assessment shall be used to calculate the assessment under
18this paragraph.
19    (b) (Blank).
20    (b-5)(1) Subject to Sections 5A-3 and 5A-10, for the
21portion of State fiscal year 2012, beginning June 10, 2012
22through June 30, 2012, and for State fiscal years 2013 through
232018, or as provided in Section 5A-16, an annual assessment on
24outpatient services is imposed on each hospital provider in an
25amount equal to .008766 multiplied by the hospital's
26outpatient gross revenue, provided, however, that the amount

 

 

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1of .008766 shall be increased by a uniform percentage to
2generate an amount equal to 25% of the State share of the
3payments authorized under Section 5A-12.5, with such increase
4only taking effect upon the date that a State share for such
5payments is required under federal law. For the period
6beginning June 10, 2012 through June 30, 2012, the annual
7assessment on outpatient services shall be prorated by
8multiplying the assessment amount by a fraction, the numerator
9of which is 21 days and the denominator of which is 365 days.
10For the period of April through June 2015, the amount of
11.008766 used to calculate the assessment under this paragraph
12shall, by emergency rule under subsection (s) of Section 5-45
13of the Illinois Administrative Procedure Act, be increased by
14a uniform percentage to generate $6,750,000 in the aggregate
15for that period from all hospitals subject to the annual
16assessment under this paragraph.
17    (2) In addition to any other assessments imposed under
18this Article, effective July 1, 2016 and semi-annually
19thereafter through June 2018, in addition to any federally
20required State share as authorized under paragraph (1), the
21amount of .008766 shall be increased by a uniform percentage
22to generate an amount equal to 25% of the ACA Assessment
23Adjustment, as defined in subsection (b-6) of this Section.
24    For the portion of State fiscal year 2012, beginning June
2510, 2012 through June 30, 2012, and State fiscal years 2013
26through 2018, or as provided in Section 5A-16, a hospital's

 

 

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1outpatient gross revenue shall be determined using the most
2recent data available from each hospital's 2009 Medicare cost
3report as contained in the Healthcare Cost Report Information
4System file, for the quarter ending on June 30, 2011, without
5regard to any subsequent adjustments or changes to such data.
6If a hospital's 2009 Medicare cost report is not contained in
7the Healthcare Cost Report Information System, then the
8Department may obtain the hospital provider's outpatient gross
9revenue from any source available, including, but not limited
10to, records maintained by the hospital provider, which may be
11inspected at all times during business hours of the day by the
12Department or its duly authorized agents and employees.
13    (3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State
14fiscal years 2019 and 2020, an annual assessment on outpatient
15services is imposed on each hospital provider in an amount
16equal to .01358 multiplied by the hospital's outpatient gross
17revenue. For State fiscal years 2019 and 2020, a hospital's
18outpatient gross revenue shall be determined using the most
19recent data available from each hospital's 2015 Medicare cost
20report as contained in the Healthcare Cost Report Information
21System file, for the quarter ending on March 31, 2017, without
22regard to any subsequent adjustments or changes to such data.
23If a hospital's 2015 Medicare cost report is not contained in
24the Healthcare Cost Report Information System, then the
25Department may obtain the hospital provider's outpatient gross
26revenue from any source available, including, but not limited

 

 

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1to, records maintained by the hospital provider, which may be
2inspected at all times during business hours of the day by the
3Department or its duly authorized agents and employees.
4Notwithstanding any other provision in this Article, for a
5hospital provider that did not have a 2015 Medicare cost
6report, but paid an assessment in State fiscal year 2018 on the
7basis of hypothetical data, that assessment amount shall be
8used for State fiscal years 2019 and 2020.
9    (4) Subject to Sections 5A-3 and 5A-10, for the period of
10July 1, 2020 through December 31, 2020 and calendar years 2021
11and 2022, an annual assessment on outpatient services is
12imposed on each hospital provider in an amount equal to .01525
13multiplied by the hospital's outpatient gross revenue,
14provided however: (i) for the period of July 1, 2020 through
15December 31, 2020, the assessment shall be equal to 50% of the
16annual amount; and (ii) the amount of .01525 shall be
17retroactively adjusted by a uniform percentage to generate an
18amount equal to 50% of the Assessment Adjustment, as defined
19in subsection (b-7). For the period of July 1, 2020 through
20December 31, 2020 and calendar years 2021 and 2022, a
21hospital's outpatient gross revenue shall be determined using
22the most recent data available from each hospital's 2015
23Medicare cost report as contained in the Healthcare Cost
24Report Information System file, for the quarter ending on
25March 31, 2017, without regard to any subsequent adjustments
26or changes to such data. If a hospital's 2015 Medicare cost

 

 

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1report is not contained in the Healthcare Cost Report
2Information System, then the Illinois Department may obtain
3the hospital provider's outpatient revenue data from any
4source available, including, but not limited to, records
5maintained by the hospital provider, which may be inspected at
6all times during business hours of the day by the Illinois
7Department or its duly authorized agents and employees. Should
8the change in the assessment methodology above for fiscal
9years 2021 through calendar year 2022 not be approved prior to
10July 1, 2020, the assessment and payments under this Article
11in effect for fiscal year 2020 shall remain in place until the
12new assessment is approved. If the change in the assessment
13methodology above for July 1, 2020 through December 31, 2022,
14is approved after June 30, 2020, it shall have a retroactive
15effective date of July 1, 2020, subject to federal approval
16and provided that the payments authorized under Section 12A-7
17have the same effective date as the new assessment
18methodology. In giving retroactive effect to the assessment
19approved after June 30, 2020, credit toward the new assessment
20shall be given for any payments of the previous assessment for
21periods after June 30, 2020. Notwithstanding any other
22provision of this Article, for a hospital provider that did
23not have a 2015 Medicare cost report, but paid an assessment in
24State Fiscal Year 2020 on the basis of hypothetical data, the
25data that was the basis for the 2020 assessment shall be used
26to calculate the assessment under this paragraph.

 

 

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1    (b-6)(1) As used in this Section, "ACA Assessment
2Adjustment" means:
3        (A) For the period of July 1, 2016 through December
4    31, 2016, the product of .19125 multiplied by the sum of
5    the fee-for-service payments to hospitals as authorized
6    under Section 5A-12.5 and the adjustments authorized under
7    subsection (t) of Section 5A-12.2 to managed care
8    organizations for hospital services due and payable in the
9    month of April 2016 multiplied by 6.
10        (B) For the period of January 1, 2017 through June 30,
11    2017, the product of .19125 multiplied by the sum of the
12    fee-for-service payments to hospitals as authorized under
13    Section 5A-12.5 and the adjustments authorized under
14    subsection (t) of Section 5A-12.2 to managed care
15    organizations for hospital services due and payable in the
16    month of October 2016 multiplied by 6, except that the
17    amount calculated under this subparagraph (B) shall be
18    adjusted, either positively or negatively, to account for
19    the difference between the actual payments issued under
20    Section 5A-12.5 for the period beginning July 1, 2016
21    through December 31, 2016 and the estimated payments due
22    and payable in the month of April 2016 multiplied by 6 as
23    described in subparagraph (A).
24        (C) For the period of July 1, 2017 through December
25    31, 2017, the product of .19125 multiplied by the sum of
26    the fee-for-service payments to hospitals as authorized

 

 

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1    under Section 5A-12.5 and the adjustments authorized under
2    subsection (t) of Section 5A-12.2 to managed care
3    organizations for hospital services due and payable in the
4    month of April 2017 multiplied by 6, except that the
5    amount calculated under this subparagraph (C) shall be
6    adjusted, either positively or negatively, to account for
7    the difference between the actual payments issued under
8    Section 5A-12.5 for the period beginning January 1, 2017
9    through June 30, 2017 and the estimated payments due and
10    payable in the month of October 2016 multiplied by 6 as
11    described in subparagraph (B).
12        (D) For the period of January 1, 2018 through June 30,
13    2018, the product of .19125 multiplied by the sum of the
14    fee-for-service payments to hospitals as authorized under
15    Section 5A-12.5 and the adjustments authorized under
16    subsection (t) of Section 5A-12.2 to managed care
17    organizations for hospital services due and payable in the
18    month of October 2017 multiplied by 6, except that:
19            (i) the amount calculated under this subparagraph
20        (D) shall be adjusted, either positively or
21        negatively, to account for the difference between the
22        actual payments issued under Section 5A-12.5 for the
23        period of July 1, 2017 through December 31, 2017 and
24        the estimated payments due and payable in the month of
25        April 2017 multiplied by 6 as described in
26        subparagraph (C); and

 

 

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1            (ii) the amount calculated under this subparagraph
2        (D) shall be adjusted to include the product of .19125
3        multiplied by the sum of the fee-for-service payments,
4        if any, estimated to be paid to hospitals under
5        subsection (b) of Section 5A-12.5.
6    (2) The Department shall complete and apply a final
7reconciliation of the ACA Assessment Adjustment prior to June
830, 2018 to account for:
9        (A) any differences between the actual payments issued
10    or scheduled to be issued prior to June 30, 2018 as
11    authorized in Section 5A-12.5 for the period of January 1,
12    2018 through June 30, 2018 and the estimated payments due
13    and payable in the month of October 2017 multiplied by 6 as
14    described in subparagraph (D); and
15        (B) any difference between the estimated
16    fee-for-service payments under subsection (b) of Section
17    5A-12.5 and the amount of such payments that are actually
18    scheduled to be paid.
19    The Department shall notify hospitals of any additional
20amounts owed or reduction credits to be applied to the June
212018 ACA Assessment Adjustment. This is to be considered the
22final reconciliation for the ACA Assessment Adjustment.
23    (3) Notwithstanding any other provision of this Section,
24if for any reason the scheduled payments under subsection (b)
25of Section 5A-12.5 are not issued in full by the final day of
26the period authorized under subsection (b) of Section 5A-12.5,

 

 

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1funds collected from each hospital pursuant to subparagraph
2(D) of paragraph (1) and pursuant to paragraph (2),
3attributable to the scheduled payments authorized under
4subsection (b) of Section 5A-12.5 that are not issued in full
5by the final day of the period attributable to each payment
6authorized under subsection (b) of Section 5A-12.5, shall be
7refunded.
8    (4) The increases authorized under paragraph (2) of
9subsection (a) and paragraph (2) of subsection (b-5) shall be
10limited to the federally required State share of the total
11payments authorized under Section 5A-12.5 if the sum of such
12payments yields an annualized amount equal to or less than
13$450,000,000, or if the adjustments authorized under
14subsection (t) of Section 5A-12.2 are found not to be
15actuarially sound; however, this limitation shall not apply to
16the fee-for-service payments described in subsection (b) of
17Section 5A-12.5.
18    (b-7)(1) As used in this Section, "Assessment Adjustment"
19means:
20        (A) For the period of July 1, 2020 through December
21    31, 2020, the product of .3853 multiplied by the total of
22    the actual payments made under subsections (c) through (k)
23    of Section 5A-12.7 attributable to the period, less the
24    total of the assessment imposed under subsections (a) and
25    (b-5) of this Section for the period.
26        (B) For each calendar quarter beginning on and after

 

 

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1    January 1, 2021, the product of .3853 multiplied by the
2    total of the actual payments made under subsections (c)
3    through (k) of Section 5A-12.7 attributable to the period,
4    less the total of the assessment imposed under subsections
5    (a) and (b-5) of this Section for the period.
6    (2) The Department shall calculate and notify each
7hospital of the total Assessment Adjustment and any additional
8assessment owed by the hospital or refund owed to the hospital
9on either a semi-annual or annual basis. Such notice shall be
10issued at least 30 days prior to any period in which the
11assessment will be adjusted. Any additional assessment owed by
12the hospital or refund owed to the hospital shall be uniformly
13applied to the assessment owed by the hospital in monthly
14installments for the subsequent semi-annual period or calendar
15year. If no assessment is owed in the subsequent year, any
16amount owed by the hospital or refund due to the hospital,
17shall be paid in a lump sum.
18    (3) The Department shall publish all details of the
19Assessment Adjustment calculation performed each year on its
20website within 30 days of completing the calculation, and also
21submit the details of the Assessment Adjustment calculation as
22part of the Department's annual report to the General
23Assembly.
24    (c) (Blank).
25    (d) Notwithstanding any of the other provisions of this
26Section, the Department is authorized to adopt rules to reduce

 

 

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1the rate of any annual assessment imposed under this Section,
2as authorized by Section 5-46.2 of the Illinois Administrative
3Procedure Act.
4    (e) Notwithstanding any other provision of this Section,
5any plan providing for an assessment on a hospital provider as
6a permissible tax under Title XIX of the federal Social
7Security Act and Medicaid-eligible payments to hospital
8providers from the revenues derived from that assessment shall
9be reviewed by the Illinois Department of Healthcare and
10Family Services, as the Single State Medicaid Agency required
11by federal law, to determine whether those assessments and
12hospital provider payments meet federal Medicaid standards. If
13the Department determines that the elements of the plan may
14meet federal Medicaid standards and a related State Medicaid
15Plan Amendment is prepared in a manner and form suitable for
16submission, that State Plan Amendment shall be submitted in a
17timely manner for review by the Centers for Medicare and
18Medicaid Services of the United States Department of Health
19and Human Services and subject to approval by the Centers for
20Medicare and Medicaid Services of the United States Department
21of Health and Human Services. No such plan shall become
22effective without approval by the Illinois General Assembly by
23the enactment into law of related legislation. Notwithstanding
24any other provision of this Section, the Department is
25authorized to adopt rules to reduce the rate of any annual
26assessment imposed under this Section. Any such rules may be

 

 

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1adopted by the Department under Section 5-50 of the Illinois
2Administrative Procedure Act.
3(Source: P.A. 100-581, eff. 3-12-18; 101-10, eff. 6-5-19;
4101-650, eff. 7-7-20; reenacted by P.A. 101-655, eff.
53-12-21.)